Citation Nr: 21009762 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 17-23 975 DATE: February 23, 2021 ORDER Entitlement to service connection for a dental disability that resulted in the loss of teeth numbers 7 through 10 for VA compensation purposes is granted. FINDING OF FACT The Veteran's dental disability resulting in the loss of teeth numbers 7 through 10 is etiologically related to an in-service injury and event; and is a dental condition for which compensation benefits are available. CONCLUSION OF LAW The criteria for service connection for a dental disability resulting in the loss of teeth numbers 7 through 10 for VA compensation purposes have been met. 38 U.S.C. § 1101, 1110, 1131, 1154, 5107; 38 C.F.R. § 3.303, 3.30. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1960 to February 1964. This matter comes to the Board of Veterans' Appeals (Board) from an August 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO. In May 2019, a Travel Board hearing was held before the undersigned. A transcript of that hearing is of record. In September 2019, the Board remanded this claim for additional development. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.§ 1110, 1131; 38 C.F.R. § 3.303(a). Initially, any dental disorder at issue is not an enumerated "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions based on "chronic" symptoms in service and "continuous" symptoms since service at 38 C.F.R. § 3.303(b) do not apply here. Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). Under 38 C.F.R. § 3.303(a), service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Under 38 C.F.R. § 3.303(d), disorders diagnosed after discharge may also still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Under VA regulations, VA compensation is available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, limited motion of the temporomandibular articulation, loss of the condyloid or coronoid process, or loss of any part of the hard palate. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met, as already discussed above. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161. The significance of a veteran having a service-connected compensable dental disability or condition is that he or she may be authorized any dental treatment indicated as reasonably necessary to maintain oral health and masticatory function. There is no time limitation for making an application for treatment and no restriction as to the number of repeat episodes of treatment. 38 C.F.R. § 17.161(a) (referred to as "Class I" eligibility). In determining whether service connection is warranted, the Board shall consider the benefit of the doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Entitlement to service connection for a dental disability The Veteran asserts that his in-service dental trauma resulted in his current dental disability. In April 2017, the Veteran provided an explanation as to his recollections of the in-service injury and the subsequent treatment for the in-service dental trauma. He explained that, during service, while he played football, he injured his top tooth, which turned black. The Board notes that the Veteran is considered competent to report the observable manifestations of his claimed disability. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). The Veteran has consistently asserted that he had dental trauma that was as due to a football injury during his service. Specifically, the Veteran testified at his May 2019 Board hearing that he chipped one of his front teeth. During the Board hearing, the Veteran provided additional testimony regarding his treatment for the dental trauma and the deterioration of the disability. In November 2020, the Veteran was afforded a VA dental examination. At that time, the Veteran reported the in-service injury noted above. The examiner noted that the initial injury occurred to his front tooth #8. The Veteran, in providing the history, explained that due to the injury he was told by his dentist that he needed his front 4 teeth removed and to have a bridge made from his canines 6 and 11. The examiner diagnosed the Veteran with loss of teeth. The examiner noted that the Veteran currently has a maxillary denture which has inadequate retention especially around the maxillary anterior area. The examiner also noted that the Veteran likely has significant bone loss due to the loss of teeth #7 to 10. The examiner also provided a nexus opinion, concluding that the in-service dental trauma at least as likely as not caused damage to the Veteran’s jaw, explaining that it likely led to malocclusion and poor biting forces. Based on the medical evidence, it is clear that the first element to establish service connection, a current disability, has clearly been met. Turning to the next element, the in-service dental trauma. The Board notes that the November 2020 Supplemental Statement of the Case the RO conceded the Veteran’s in-service dental trauma, therefore conceding the in-service injury. The remaining question before the Board is whether the Veteran has a dental disability that is etiologically related to, or aggravated by, an in-service disease or injury. The Board finds that the competent, credible, and probative evidence establishes that the Veteran's dental disability is etiologically related to his active military service. While the RO denied service connection as it correctly pointed out that the dental procedure of extraction of teeth is not a proper cause for service connection. However, the Board finds that RO did not fully take into consideration the entirety of the VA examiner’s opinion, which the Board finds included the opinion that the original in-service trauma of his football injury (i.e., the injury that discolored the Veteran’s #8 tooth) caused damage to the jaw that in turn led to the loss of teeth numbers 7 thorough 10. As noted above, the Veteran has been diagnosed with loss of teeth. Under current legal authority, compensation benefits are only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. However, compensation is also available for loss of teeth if such is due to loss of substance of body of maxilla or mandible. Therefore, giving the Veteran the benefit of the doubt, the Board finds that the Veteran's loss of teeth numbers 7 through 10 constitutes a dental condition for which service connection may be granted. There is also no competent VA medical opinion of record against the claim; in fact, the only opinion of record supports the Veteran’s contention. In light of the objective medical evidence, and the Veteran's credible and competent statements in support of his claim, the Board finds that the evidence is at least in equipoise regarding service connection for a dental disability resulting in the loss of teeth numbers 7 through 10. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for a dental disability resulting in the loss of teeth numbers 7 through 10 for VA compensation purposes is warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. R. Montalvo, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.